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RMF Bidibidi Healthcare Project: From Planning to Serving Over 100,000 Refugees October 7, 2016 By Naku Charles Lwanga Background

The violence that broke out in South Sudan in early July 2016 drastically increased the number of refugees fleeing to Uganda. Between July 1, 2016 and September 21, 2016, 163,540 South Sudanese refugees arrived in

Uganda. Every Ugandan border point with South Sudan became an entry point for refugees, with most entering through the Elegu border. Refugees who had been to Uganda before and had some money immediately traveled to established settlements in Kiryandongo, Adjumani, Koboko, Moyo, and Arua districts, but the highest percentage of refugees stayed at the Pagirinya Transit Centre in Adjumani. Since the situation was not going to improve in the short run, creative and better solutions were sought. In order to generate solutions, an emergency interagency meeting was convened by the UNHCR and OPM (Office of the Prime Minister) in Kampala, at the OPM’s offices. Among the resolutions adopted during the meeting, was one dispatching a Joint Assessment Mission to Uganda’s West Nile region to find a place where this new influx of refugees could be settled. Partner organizations (including RMF) who would be able to support different sectors were encouraged to join the mission. Upon our return from West Nile, the Joint Assessment Mission resolved to settle the new influx of refugees at Bidibidi Refugee Settlement in Yumbe District. Within this context, RMF was selected as the main UNHCR Health Implementing Partner, complemented by IRC for reproductive health, ACF and Concern Worldwide for Nutrition, and of course the UNHCR. Pagirinya Transit Centre was now very congested, and existing refugee settlements were filled with numbers exceeding their capacity. All services were exhausted, and fear of a disease outbreak, such as cholera, was running high. It was necessary to open Bidibidi Refugee Settlement within a very short time, increasing the pace of work, decision making, and accurately identifying priorities, especially priorities that would be lifesaving. What must be kept in mind is that Bidibidi started as fields and thickets, and every service had to be built from the ground up.

Beginning of Bidibidi Refugee Settlement

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Settlement pattern in Bidibidi Refugee Settlement

RMF’s Presence On July 30, 2016, RMF’s team arrived in Bidibidi, preparing to provide medical care for the thousands of refugees that would be ferried from transit centers and other settlements starting on August 5, 2016. RMF approached the situation by:

• Recruiting an initial medical team: In order to respond quickly and accurately, RMF dispatched a medical team comprised of:

o 1 medical doctor, o 1 clinical officer, o 2 laboratory technician, o 2 nursing officers, o 1 pediatric nurse/HIV/AIDS Counselor, o 1 midwife, o 1 admin staff, and o Several support staff members.

(This team was part of RMF’s medical team working in Kiryandongo; this team worked until payable volunteers were recruited and indicated.)

• Recruiting payable volunteers: In order not to interfere with our program performance in Kiryandongo, it was necessary to immediately recruit payable volunteers to support the new Bidibidi program in Yumbe. These volunteers included:

o 2 medical doctors, o 4 nursing officers, o 2 clinical officers, o 1 midwife, o 3 cleaners, o 2 security guards, and o 2 admin staff members.

• Recruiting additional staff as the number of refugees grows: Later, the number of RMF workers in Bidibidi increased from 22 to 39, and our team per this October now includes 41 members:

RMF Uganda’s Bidibidi Team

Cadre Number

RMF Medical Coordinator (for supervision) 1

Medical Officers 2

Nursing Officers 2

Enrolled Nurses 7

Clinical Officers 5

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Midwives 6

Laboratory Technician 1

Laboratory Assistants 2

Data Clerks 2

Interpreters 4

Guards 2

Cleaners 6

Accountant 1

Total 41

Essential Items Purchased by RMF to Establish the First Health Clinic

The first items that RMF purchased included medical and non-medical supplies essential to establishing a clinic and saving lives. Available funds were limited, and yet we wanted our impact to be felt. The team brainstormed together, and compiled a list of the most essential items, which we then purchased:

EQUIPMENT AND RELATED ITEMS Tents Pieces 2

Plastic Chairs Pieces 40

Benches with Backrests Pieces 20

Laptop 1

Printer 11

Office Tables Pieces 5

MEDICAL EQUIPMENT

Delivery Beds 4

Examination Beds (Couches) 4

Fetoscopes 2

Blood Pressure Machines 4

Delivery Kits 6

Mattresses for Hospitals 40

Blankets and Bed Sheets 40

Workbench

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Drip Stands Pieces 30

Bed Screens Pieces 4

Autoclave/Sterilizer Pieces 1

Waste Bins Pieces 10

Safety Box (Sharp box) Pieces 6

Stethoscopes Pieces 4

Trolleys (for instruments) Pieces 4

Cupboards Pieces 10

Office Phones Pieces 3

Reflectors Pieces 40

Gumboots Pieces 40

Hospital Beds 10

LABORATORY EQUIPMENT

Weight Scale 1

Glucometer 1

Assorted Pharmaceuticals Laboratory Reagents Lump sum

Malaria Testing Kits Lump sum

Syphilis Testing Kits Lump sum

HCG Testing Kits Lump sum

Essential Drugs Lump sum

Total

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Patients at the health center, waiting to be treated

Government Policy and Challenges In Bidibidi Refugee Settlement, managed primarily by the OPM, refugees are settled according to the following policies:

• On arrival, refugees stay only 24 hours at the Reception Centre. Within that period, refugees should be settled on their own plot of land.

• Refugees in Bidibidi Refugee Settlement are settled far from the Reception Centre in order to avoid congestion, possible disease outbreaks, risk of accidents, and risk of stampedes. This policy is also to ensure space economy and adherence to the settlement’s physical plan.

Although these policies have helped prevent some possible problems, they have also created new challenges that RMF and partners are working to address. These challenges include:

Additional Health Facilities

Since refugees had been settled far from the Reception Centre where the health facility was located, it became necessary to establish another health center closer to where people were living. This called for additional personnel, medical and cleaning supplies, furniture, and office supplies. In order to bridge the gap, RMF Uganda had to use its already stretched resources to purchase more hospital supplies and hire additional manpower. Currently, Bidibidi Refugee Settlement is divided into 5 zones, and as of early October, Bidibidi’s 3 zones are occupied by a population of 131,352 refugees. Zone 4 and Zone 5 are to be opened at any time now, because the influx is increasing. Bidibidi Refugee settlement was originally designed/estimated to accommodate 100,000 refugees, but with new areas opening, its estimated capacity is 180,000.

Essential Hospital Items Purchased by RMF

o 40 hospital mattresses o 40 hospital blankets o 40 pairs of bed sheets o 2 filing cabinets o 30 drip stands o 4 screens o 2 weighing scales o 4 examination coaches o 4 delivery beds o 10 hospital beds o Thermometers o 20 benches for patients o 20 chairs for staff o 1 laptop

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o Stationery o 4 trolleys for instruments o 2 tents o 1 drum designed to work as incinerator

Referral Mechanism

Realizing that the health facilities in host communities surrounding Bidibidi Refugee Settlement are ill-equipped, RMF quickly initiated a collaboration with Yumbe Hospital so that cases requiring surgery or other specialized treatment can be referred to Yumbe Hospital. Through this collaboration, RMF Medical Officers provide professional services to Yumbe Hospital, and Yumbe Hospital provides RMF with unlimited access to their facilities for the benefit of refugees. This has improved the referral mechanism.

Ambulance Services

From the beginning of our involvement in Bidibidi Refugee Settlement, UNHCR promised to support the program with two ambulances, but they have not yet done so. As a creative short-term solution, RMF (with permission from UNHCR) relocated one ambulance from Kiryandongo to support Bidibidi. This has been critical in saving the lives of people of concern. Since one ambulance was not sufficient, UNHCR relocated another ambulance from Arua operations (under MTI) to the Bidibidi Refugee Settlement.

Support from UNHCR

As of early October, RMF has not yet received any funding from UNHCR for our Bidibidi operations, apart from: o Some temporary shelters for health facilities and o Fuel for the ambulances.

RMF’s Current Needs for the Bidibidi Healthcare Project:

o Additional finances to recruit sufficient staff (Otherwise, our staff will continue to be overworked and under constraint. They work every day with no time off, even on weekends.)

o Another ambulance to strengthen the referral mechanism o Protective gear for staff members o Additional finances for staff insurance o Sufficient funds to purchase all the required medicine

We are currently overwhelmed by the quickly increasing numbers of refugees, and RMF is left with the burden of purchasing medications, as the IRC and UNHCR have not yet purchased these supplies. To minimize transportation costs, medications have been purchased in the nearby district of Koboko, which has bigger pharmacies than Yumbe. The medications are then transported by ambulance from Koboko to Bidibidi Refugee Settlement. RMF Achievements in Bidibidi Despite the fact that RMF has not yet received any funds from UNHCR, we are performing our duties as the main Health Implementing Partner:

• Providing a medical team of 41 medical staff headed by Medical Officers • Curbing an early cholera outbreak in Bidibidi Refugee Settlement • Establishing additional services including birthing services • Supporting the referral mechanism • Providing medication, medical supplies, and cleaning supplies to sustain the health project • Providing medical equipment (hospital beds, mattresses, delivery beds, examination couches, etc.) • Providing a temporary incinerator • Excavating a placenta pit • Providing stationery (to work as medical forms) for patients • Supporting patients who are referred to the regional referral hospital in Arua through financial facilitation

of the patient and the caretaker • Conducting consistent health outreaches to provide health education and prevention

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Project Photos

Dealing with suspected cholera cases

Extending health services to people deep within the settlement

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3-month-old twins Akelo and Odongo are malnourished and suffering from malaria. RMF’s medical team is treating them.

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Some of the hospital beds being assembled in a ward at Bidibidi Refugee Settlement

Furnishing a ward with medical equipment at Bidibidi Refugee Settlement

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Items purchased by RMF being unloaded from a truck